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Pre-Summit Questionnaire
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Questionaire
First Name
Last Name
Phone
Email
Nationality
- Nationality -
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d’Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor-Leste)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Fiji
Finland
France
Gabon
The Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia, Federated States of
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
North Macedonia
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Age
Name of Company/Organization
Current Occupation/Profession
Possition/Title
Which sector(s) do you primarily influence or aim to influence?
Government/Politics
Business/Entrepreneurship
Education
Health and Wellness
Media/Communication
Arts and Entertainment
Religion/Faith
Family and Community
Other (Please specify)
Specify
How long have you been in your current leadership role?
Less than 1 year
1-3 years
3-5 years
More than 5 years
What leadership skills do you currently possess? (Select all that apply)
Strategic Thinking
Communication
Team Building
Conflict Resolution
Decision Making
Emotional Intelligence
Other (Please specify):
Specify
Which leadership skills do you wish to develop further? (Select all that apply)
Strategic Thinking
Communication
Team Building
Conflict Resolution
Decision Making
Emotional Intelligence
Other (Please specify)
Specify
What motivated you to attend this leadership summit?
What specific outcomes do you hope to achieve by the end of the summit? (Select all that apply)
Network with other leaders
Gain new leadership skills
Learn from the experiences of the speakers
Find a mentor/coach
Develop a personal action plan for leadership
Other (Please specify).
Specify
How do you plan to apply the knowledge and skills gained from the summit in your sphere of influence?
What challenges do you currently face in your leadership journey? (Select all that apply)
Lack of mentorship
Limited resources
Work-life balance
Gender bias
Other (Please specify)
Specify
Do you have any specific questions or topics you would like the speakers to address during the summit?
How did you hear?
• Hadassah Women’s Ministry Website
• Social Media
• Referral from a Friend/Colleague
• Other (Please specify):
Specify
Would you be interested in participating in post-summit mentoring and coaching programmes?
Yes
No
Maybe
Comment and Suggestions
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